The Etiology and Treatment of Peptic Esophagitis

Active and passive opening of the cardia and its relation to the pathogenesis of hiatus hernia.

“…Muscle spasm is usual in inflammation, and since the longitudinal muscle of the gullet is attached indirectly to the base of the skull, its contraction must necessarily elevate the cardia. The observation that oesophagitis could often be seen at oesophagoscopy and proved by biopsy in patients who showed no radiological evidence of herniation (Johnson, 1955, Conway-Hughes, 1956, Cross, Smith, and Kay, 1959 was consistent with the view that oesophagitis might precede and cause hiatal herniation of the short-oesophagus type. Moreover, oesophagitis without herniation has been more frequent among my younger patients with heartburn, a greater proportion of my older patients with this symptom having had established, sliding hernias.…”

Mechanisms protecting against gastro-oesophageal reflux: a review

“…Of 130 patients with free gastro-oesophageal reflux, Cross et al (1959) could find no hernia in 27 and Conway-Hughes (1956) was able to demonstrate a hernia in only 30 of 54 patients with free reflux. Stensrud (1957) attributed incompetence of the cardia without hiatus hernia to loss of the oesophagogastric angle and both he and Hiebert and Belsey (1961) obtained good therapeutic results by suturing the fundus to the oesophagus to re-create the angle.…”

“…Controversy has centred round the value of repair of hiatus hernia in controlling symptoms of reflux; although Wells and Johnston (1955) abandoned this operation in favour of vagotomy, partial gastrectomy, and re-anastomosis by the Roux en Y method, and Merendino and Dillard (1955) used a method of jejunal interposition, there is now an increasing amount of evidence to indicate that repair of the hernia will diminish or abolish symptoms of gastro-oesophageal reflux (Allison, 1951;Harrington 1955;Cross, Smith, and Kay, 1959;Barrett, 1960;Wooler, 1961). Amongst the advocates of hernial repair there is, however, no general agreement as to how this helps to reduce reflux; some believe that repair of the hiatus is of cardinal importance (Harrington, 1955;Wooler, 1961) but others lay stress on avoiding a tight hiatus because of the risk of dysphagia and emphasize the importance of reconstituting the oesophagogastric angle (Humphreys, Ferrer, and Wiedel, 1957;Goldberg, 1960).…”

Hiatus Hernia with Esophagitis and Acute Hemorrhage

“…Case 1.-A 70-year-okl white man was admitted on Jan. 4,1960, with recurrent hematemesis and melena for 3 days. He had had 4 previous episodes of bleeding from the upper gastrointestinal tract during the past 5 years, which had been diagnosed as bleeding peptic ulcer.…”